Provider Demographics
NPI:1760512305
Name:HERNANDEZ, JESSICA MONIQUE (AA, BA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MONIQUE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AA, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10221 COMPTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WATTS
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2805
Mailing Address - Country:US
Mailing Address - Phone:310-431-5996
Mailing Address - Fax:
Practice Address - Street 1:10221 COMPTON AVE STE 104
Practice Address - Street 2:
Practice Address - City:WATTS
Practice Address - State:CA
Practice Address - Zip Code:90002-2805
Practice Address - Country:US
Practice Address - Phone:310-431-5996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator